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County EMS Teams Reduce Unnecessary Emergency Room Trips

A Guilford County, N.C., program is reducing 911 emergency services costs and trips by ambulance to the ER by using regular vehicles and teams with a lower-level EMT instead of a paramedic.

Ambulances being overused is a common problem around the country as paramedics routinely transport patients to the emergency room who don’t need that type of care. The result is that others, who may truly need to be transported, are often put in a position of having to wait for the care they urgently need.

A pilot project in Guilford County, N.C., is showing that a bit of ingenuity and outside-the-box thinking can go a long way to help solve this problem by dividing 911 calls between two teams of responders: one with an ambulance and paramedics, and a lower-level team that travels in a truck or SUV with EMTs.

The Guilford County Emergency Services Department, dealing with the added costs of transporting patients to the hospital when they don’t need that level of care, developed a solution of triaging 911 callers to better determine their needs and sending a lower-level team — instead of a paramedic to every call — out to those who don’t need treatment at the emergency room.

The EMTs are paid less than paramedics, and trucks and SUVs consume less fuel than ambulances, so there is a cost savings to sending the Interagency Medical Provider Assessment and Care Team (IMPACT) in the regular vehicle instead of the traditional paramedics in the ambulance.

The 911 callers are screened as usual using the 39 dispatch codes, but, after re-evaluating the codes, EMS has defined a subset of incidents that used to require ambulance transportation but now do not. They may need to go to urgent care or their personal doctor, for instance.

The department studied nearly 300,000 calls for safety, ramifications and outcomes and determined which of the 39 codes no longer needed an ambulance.

Of the cases that dispatchers decided not to send an ambulance, 92 percent have not needed the ambulance service. For the other 8 percent, it was determined that the patient indeed needed emergency care and was then transported via ambulance.

Like most jurisdictions, Guilford County began struggling with emergency response during the COVID-19 pandemic and needed an alternative way of responding due to staffing shortages.

“We said, let’s go pilot this and see if a couple of staff members can get out in a car and take some of these emergency calls off flight — medical alarms or a small laceration or where the caller reports no injuries,” said Justin Hargett, EMS manager for quality and compliance at Guilford EMS.

They are now using the IMPACT teams for more than 100 calls per week — calls that before would have been transported by ambulance. The IMPACT calls require less time, and the teams can run between 30 percent and 50 percent more calls than the ambulance teams.

“The important part of this is we’re not refusing people, telling them they’re not going to the hospital,” Hargett said. ”But we’re able to identify calls that we probably shouldn’t have been sending an ambulance to before and now sending the right resource at the right time.”

The EMTs chosen for IMPACT were brought in to the emergency department for extra training by Hannah Muthersbaugh, assistant medical director for the department.

There, the trainees, who were already among the most experienced EMTs, spent a shift with Muthersbaugh screening patients. “They listened, asked questions, looked at patients’ vital signs and then we’d leave the room and discuss,” Muthersbaugh said.

She would go over with the trainees what type of care the patient really needed and whether they could be treated by IMPACT. “We got them comfortable with asking the right questions, making good assessments, helping patients figure out where the best place for them is and ensuring they got the right care at the right place,” Muthersbaugh said.

“That’s been our goal from the beginning of this, to make sure that these EMTs are well trained enough to know what the patient needs and how we can get them there,” she said.